For the chronically ill, health care can become an unending maze of expensive interventions with certain risks and uncertain benefits

Health care researchers are questioning whether more is better and suggesting that standardizing care for the chronically ill in the last two years of life will reduce expenditures without sacrificing patient outcomes or satisfaction. So as the health care system faces decades of growth in the number of aged patients, Americans might be asked to respond to this sobering question: How do we want to live, and how do we want to die?

“I think it’s very important that we leave cost out of the equation in considering how we care for people at the end of life,” says Roy Elam, M.D. The health care community must never support choices that appear to hasten death in order to save money, he says.

Instead, Elam believes runaway expenditures might be tamed by this undervalued health care intervention: a sincere conversation. Physicians and other health care professionals need to take more time to talk with seriously ill patients about all their options, he says, including pain management and end-of-life comfort care — instead of more tests and treatments — when they feel the time is right.  continued>>